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June 20, 1977

Metastatic Carcinoma Simulating Gout

Author Affiliations

From the Section of Rheumatology, Arthritis Center of the Albert Einstein Medical Center, Moss Rehabilitation Hospital, and Temple University School of Medicine, Philadelphia.

JAMA. 1977;237(25):2746-2747. doi:10.1001/jama.1977.03270520056025

THERE IS wisdom in demanding that the clinical diagnosis of gout, based on symptoms and signs, be confirmed by the demonstration of intracellular monosodium urate crystals in synovial fluid or tissues. The following case report details an instance in which metastatic carcinoma was responsible for acute monarthritis misinterpreted as an acute gouty attack.

Report of a Case  A 67-year-old man was first seen in the Arthritis Center because of pain in the left ankle and hindfoot. This pain, accompanied by swelling and redness, had begun six weeks previously, and the family physician was consulted. The roentgenogram showed only soft-tissue swelling (Fig 1), and serum uric acid was said to be "elevated." Because of the conjunction of acute monarthritis and hyperuricemia, the physician concluded that the patient had gout, advocated crutches to relieve weight bearing, and prescribed phenylbutazone and allopurinol. When scant improvement occurred during the next six weeks, rheumatologic consultation